scholarly journals Evaluation of cardiovascular risk in adults with type 1 diabetes: poor concordance between the 2019 ESC risk classification and 10-year cardiovascular risk prediction according to the Steno Type 1 Risk Engine

2020 ◽  
Vol 19 (1) ◽  
Author(s):  
Nicola Tecce ◽  
Maria Masulli ◽  
Roberta Lupoli ◽  
Giuseppe Della Pepa ◽  
Lutgarda Bozzetto ◽  
...  
Keyword(s):  
Type 1 Diabetes ◽  
Cardiovascular Risk ◽  
High Risk ◽  
Risk Prediction ◽  
Risk Classification ◽  
Preventive Strategy ◽  
Cvd Risk ◽  
Risk Engine ◽  
Very High

Abstract Background Patients with type 1 diabetes (T1D) have higher mortality risk compared to the general population; this is largely due to increased rates of cardiovascular disease (CVD). As accurate CVD risk stratification is essential for an appropriate preventive strategy, we aimed to evaluate the concordance between 2019 European Society of Cardiology (ESC) CVD risk classification and the 10-year CVD risk prediction according to the Steno Type 1 Risk Engine (ST1RE) in adults with T1D. Methods A cohort of 575 adults with T1D (272F/303M, mean age 36 ± 12 years) were studied. Patients were stratified in different CVD risk categories according to ESC criteria and the 10-year CVD risk prediction was estimated with ST1RE within each category. Results Men had higher BMI, WC, SBP than women, while no difference was found in HbA1c levels between genders. According to the ESC classification, 92.5% of patients aged < 35 years and 100% of patients ≥ 35 years were at very high/high risk. Conversely, using ST1RE to predict the 10-year CVD risk within each ESC category, among patients at very high risk according to ESC, almost all (99%) had a moderate CVD risk according to ST1RE if age < 35 years; among patients aged ≥35 years, the majority (59.1%) was at moderate risk and only 12% had a predicted very high risk by ST1RE. The presence of target organ damage or three o more CV risk factors, or early onset T1D of long duration (> 20 years) alone identified few patients (< 30%) among those aged ≥35 years, who were at very high risk according to ESC, in whom this condition was confirmed by ST1RE; conversely, the coexistence of two or more of these criteria identified about half of the patients at high/very high risk also according to this predicting algorithm. When only patients aged ≥ 50 years were considered, there was greater concordance between ESC classification and ST1RE prediction, since as many as 78% of those at high/very high risk according to ESC were confirmed as such also by ST1RE. Conclusions Using ESC criteria, a large proportion (45%) of T1D patients without CVD are classified at very high CVD risk; however, among them, none of those < 35 years and only 12% of those ≥ 35 years could be confirmed at very high CVD risk by the ST1RE predicting algorithm. More studies are needed to characterize the clinical and metabolic features of T1D patients that identify those at very high CVD risk, in whom a very aggressive cardioprotective treatment would be justified.

scholarly journals Predicting 10-year cardiovascular risk using WHO/ISH risk prediction chart among urban population in Salem

2018 ◽  
Vol 5 (12) ◽  
pp. 5228
Author(s):  
K. Premanandh ◽  
R. Shankar
Keyword(s):  
Cardiovascular Risk ◽  
High Risk ◽  
Risk Prediction ◽  
Disease Risk ◽  
Smoking Status ◽  
Cardiovascular Disease Risk ◽  
Total Serum ◽  
Total Serum Cholesterol ◽  
Cvd Risk ◽  
Very High

Background: Coronary vascular disease (CVD) risk estimation tools are a simple means of identifying those at high risk in a community and hence a potentially cost-effective strategy for CVD prevention in resource-poor countries. The WHO /ISH risk prediction charts provide approximate estimates of cardiovascular disease risk in people who do not have established coronary heart disease, stroke or other atherosclerotic disease.Methods: A total of 280 subjects between 40 to 70 years of age were included in this cross sectional study. Eligible households was selected randomly (every 5th household) for the interview using systematic random sampling. Age, gender, smoking status, systolic blood pressure, presence or absence of diabetes and total serum cholesterol were used to compute the total CVD risk using WHO/ISH CVD risk prediction chart. The chart stratify an individual into low (<10%), moderate (10% to <20%), high (20% to <30%), and very high (>30%) risk groups.Results: Moderate and high CVD risk were 12.14% and 7.5% respectively. Of total study participants, 2.5% had very high risk (>40%). High risk (binge drinking) alcohol drinkers (p=0.04) and abdominal obesity (p=0.0001) were significantly associated with higher CVD risk. Higher prevalence of behavioral risk factors was also reported in our study population.Conclusions: A large proportion of the population is at moderate and high cardiovascular risk. Risk stratification and identification of individuals with a high risk for CHD who could potentially benefit from intensive primary prevention efforts are critically important in reducing the burden of CVD in India.

scholarly journals Utility of Insulin Resistance in Estimating Cardiovascular Risk in Subjects with Type 1 Diabetes According to the Scores of the Steno Type 1 Risk Engine

2020 ◽  
Vol 9 (7) ◽  
pp. 2192 ◽  
Author(s):  
Albert Cano ◽  
Gemma Llauradó ◽  
Lara Albert ◽  
Isabel Mazarico ◽  
Brenno Astiarraga ◽  
...  
Keyword(s):  
Insulin Resistance ◽  
Type 1 Diabetes ◽  
Clinical Practice ◽  
Insulin Sensitivity ◽  
High Risk ◽  
Cvd Risk ◽  
C Statistic ◽  
Potential Applicability ◽  
Risk Engine

Background: We sought to assess the potential of insulin resistance (IR) for estimating cardiovascular disease (CVD) risk in adults with type 1 diabetes (T1DM) according to the scores of the Steno Type 1 Risk Engine (ST1RE). Methods: A total of 179 adults with T1DM (50.8% men, age 41.2 ± 13.1 years, duration of T1DM 16 (12–23) years) without established CVD were evaluated. IR was assessed by the estimation of insulin sensitivity (eIS) using two validated prediction equations: the estimated insulin sensitivity developed from the Pittsburgh Epidemiology of Diabetes Complications Study (eIS-EDC) and the estimated insulin sensitivity developed from Coronary Artery Calcification in T1DM Study (eIS-CACTI) ST1RE was used to estimate 10-year CVD risk and to classify subjects into three groups according to their risk: low (<10%; n = 105), moderate (10–20%; n = 53), and high (≥20%; n = 21). Results: Both eIS-EDC and eIS-CACTI correlated negatively with ST1RE scores (eIS-EDC: r = −0.636, p < 0.001; eIS-CACTI: r = −0.291, p < 0.001). The C-statistic for predicting moderate/high risk and high risk was 0.816 (95% confidence interval (CI): 0.754–0.878) and 0.843 (95% CI: 0.772–0.913), respectively, for the eIS-EDC equation, and was 0.686 (95% CI: 0.609–0.763) and 0.646 (95% CI: 0.513–0.778), respectively, for the eIS-CACTI equation. The eIS-EDC equation had a significantly higher C-statistic both for moderate-/high-risk (p = 0.001) and high-risk (p = 0.007) subjects. Two cut-off points of eIS-EDC were identified for detecting moderate/high risk (8.52 mg·kg−1·min−1; sensitivity 74% and specificity 76%) and high risk (8.08 mg·kg−1·min−1; sensitivity 65% and specificity 95%) with potential applicability in clinical practice. Conclusions: eIS negatively correlates with the score of CVD risk in the ST1RE. Two cut-off points of eIS are reported with potential utility in clinical practice for detecting adults with T1DM with the highest CVD risk.

scholarly journals Patterns of care of subjects with type 1 and type 2 diabetes according to their cardiovascular risk

2021 ◽  
Vol 24 (1) ◽  
pp. 30
Author(s):  
Pintaudi, B.
Keyword(s):  
Risk Factors ◽  
Quality Of Care ◽  
Cardiovascular Risk ◽  
High Risk ◽  
Quality Indicators ◽  
High Cardiovascular Risk ◽  
Very High

AIM OF THE STUDY To explore the distribution by cardiovascular risk groups according to the classification promoted by the ESC (European Society of Cardiology) of subjects with type 1 (T1D) and type 2 (T2D) diabetes cared for by Italian diabetologists and to describe the quality indicators of care, with particular regard to cardiovascular risk factors. DESIGN AND METHODS The study is based on data extracted from electronic medical records of patients treated at the 258 diabetes centers participating in the Annals AMD initiative and active in the year 2018. Patients with T1D or T2D were stratified by cardiovascular risk, in accordance with the recent ESC guidelines. General descriptive indicators and measures of intermediate outcomes, intensity/appropriateness of pharmacological treatment for diabetes and cardiovascular risk factors, presence of other complications and overall quality of care were evaluated. RESULTS Overall, 29,368 adults with T1D and 473,740 subjects with T2D were evaluated. Among subjects with T1D: 64.7% were at very high cardiovascular risk, 28.5% at high risk and the remaining 6.8% at moderate risk. Among subjects with T1D at very high-risk: 54.7% had retinopathy, 29.0% had albuminuria, 7.3% had a history of major cardiovascular event, 47.3% had organ damage, 48.9% had three or more risk factors, and 70.6% had a diabetes duration of over 20 years. Among subjects with T2D: 78.5% were at very high cardiovascular risk, 20.9% at high risk and the remaining 0.6% at moderate risk. Among those with T2D at very high risk: 39.0% had organ damage, 89.1% had three or more risk factors, 18.7% had a previous major cardiovascular event, 26,4% had retinopathy, 39.5% had albuminuria. With regard to the glucose-lowering drugs: the use of DPPIV-i increased markedly as cardiovascular risk increased; the use of secretagogues also increased and, although within low percentages, also the use of GLP1-RA tended to increase. The use of SGLT2-i is also still limited, and only slightly higher in subjects with very high cardiovascular risk. In both types of diabetes, the overall quality of care, as summarized by the Q score values, tended to be lower as the level of cardiovascular riskincreased. CONCLUSIONS The analysis of a large population such as that of the AMD Annals database allowed to highlight the characteristics and quality indicators of care of subjects with T1D and T2D in relation to cardiovascular risk classes. A large proportion of subjects appear to be at high or very high risk. Glucose-lowering drug therapies seem not to be adequately used with respect to the potential advantages in terms of reduction of cardiovascular risk of some drug categories (GLP1-RA and SGLT2-i) and, conversely, with respect to the potential risks related to the use of other pharmacological classes (sulfonylureas). Several actions are necessary to optimize care and improve the quality of care for both subjects with T1D and T2D. KEY WORDS type 1 diabetes; type 2 diabetes; cardiovascular risk; quality indicators of care.

scholarly journals A community based cross sectional study to estimate total cardiovascular risk in rural Punjab

2017 ◽  
Vol 4 (4) ◽  
pp. 1295
Author(s):  
Bibhava Vikramaditya ◽  
Mahesh Satija ◽  
Anurag Chaudhary ◽  
Sarit Sharma ◽  
Sangeeta Girdhar ◽  
...  
Keyword(s):  
Cardiovascular Risk ◽  
Cardiovascular Diseases ◽  
High Risk ◽  
Risk Prediction ◽  
Cross Sectional Study ◽  
World Health ◽  
Sectional Study ◽  
Cvd Risk ◽  
Community Based ◽  
Cross Sectional

Background: Cardiovascular diseases (CVD) are leading cause of non communicable deaths in India. CVD risk prediction charts by World Health Organization/International Society of Hypertension (WHO/ISH) are designed for implementing timely preventive measures. The objective of the study was to assess the prevalence of CVD risk parameters and to estimate total CVD risk among adults aged ≥40 years, using the WHO/ISH risk charts alone and also to assess the effect of the inclusion of additional criteria on CVD risk.Methods: A community based cross sectional study was conducted in fifteen villages of Ludhiana district under rural health training centre of Department of Community Medicine, Dayanand Medical College & Hospital, Ludhiana, Punjab. Desired information was obtained using WHO STEPS survey (STEP wise approach to surveillance) from 324 adults aged ≥40 years. Anthropometric, clinical and laboratory measurements were also performed. WHO/ISH risk prediction chart for South East Asian region (SEAR-D) was used to assess the cardiovascular risk among the subjects.Results: WHO/ISH risk prediction charts identified 16.0% of the subjects with high risk (≥20%) of developing a cardiovascular event. The study population showed higher prevalence of physical inactivity, obesity, abdominal obesity, hypertension and diabetes. Amongst high risk CVD group, maximum prevalence was of hypertension and high perceived stress level. However, the proportion of high CVD risk (≥20%) increased to 33.6% when subjects with blood pressure ≥160/100 mmHg and /or on hypertension medication were added as high risk.Conclusions: A substantial proportion of this community is at high risk of developing cardiovascular diseases.

P2487Echocardiography and NT-ProBNP both provide independent and improved prediction of prognosis in a type 1 diabetes population without heart disease and with preserved ejection fraction

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
R Roerth ◽  
P G Jorgensen ◽  
H U Andersen ◽  
J P Goetze ◽  
P Rossing ◽  
...  
Keyword(s):  
Type 1 Diabetes ◽  
Heart Disease ◽  
Ejection Fraction ◽  
Risk Prediction ◽  
Cardiovascular Events ◽  
Left Ventricular ◽  
Left Ventricular Ejection ◽  
Risk Engine

Abstract Background Cardiovascular disease is the most common comorbidity in type 1 diabetes (T1D). Current guidelines, however, do not include routine echocardiography or cardiac biomarkers in T1D. Objectives To investigate if echocardiography and NT-proBNP provide incremental prognostic information in individuals with T1D without heart disease and with preserved left ventricular ejection fraction (LVEF). Methods A prospective cohort of individuals with T1D without heart disease and with preserved LVEF (≥45%) from the outpatient clinic were included. Follow-up was performed through Danish national registers. The association between E/e', a marker of diastolic function, from echocardiography and NT-proBNP with major adverse cardiovascular events (MACE) was tested. MACE was defined as death from all-causes, acute coronary syndromes, cardiac revascularization, incident heart failure, or stroke. Additionally, the incremental prognostic value when adding E/e' and NT-proBNP to the clinical Steno T1D Risk Engine score (including age, sex, duration of diabetes, systolic blood pressure, LDL, HbA1c, presence of albuminuria (micro-or macroalbuminuria), eGFR, smoking status, and physical activity [low, medium, high]), was examined. Follow-up was 100% complete. Results Of 964 individuals (mean (SD)) age 49.7 (14.5) years, 51% men, HbA1c 66 (14) mmol/mol, BMI 25.6 (4.0) kg/m2, and diabetes duration 26.1 (14.5) years), 121 (12.6%) experienced MACE during 7.5 years of follow-up. In the full multivariable model, E/e' significantly and independently predicted MACE: (HR (95%)) E/'e <8 (n=639) vs. 8–12 (n=248): 2.00 (1.23; 3.25), p=0.005, E/'e <8 vs E/e'≥12 (n=77): 3.36 (1.8; 6.1), p<0.001. Also, NT-proBNP significantly predicted outcome: NT-proBNP <150 pg/ml (n=435) vs. 150–450 pg/ml (n=386): 1.52 (0.9; 2.5), p=0.11, NT-proBNP <150 pg/ml vs NT-proBNP >450 pg/ml (n=143): 2.78 (1.6; 4.9), p<0.001. Adding both (log)E/e' and (log)NT-proBNP to the Steno T1D Risk Engine score significantly and incrementally improved risk prediction: Harrell's C-index: Steno T1D Risk Engine (AUC 0.783 (0.747; 0.818)) vs. Steno T1D Risk Engine + (log)E/e' (AUC 0.805 (0.773; 0.837)): p<0.001 and Steno T1D Risk Engine + (log)E/e' + (log) NT-proBNP (AUC 0.816 (0.783; 0.848)): p=0.002. The risk of MACE by groups of E/e' and NT-proBNP is shown in the figure. Figure 1 Conclusion In individuals with T1D without heart disease and with preserved LVEF, E/e' and NT-proBNP significantly improved risk prediction of cardiovascular events beyond clinical risk factors alone. Echocardiography and NT-proBNP could have a role in clinical care.

scholarly journals Primary Prevention of Cardiovascular Risk in Lithuania—Results from EUROASPIRE V Survey

Medicina ◽  
2020 ◽  
Vol 56 (3) ◽  
pp. 134
Author(s):  
Gediminas Urbonas ◽  
Lina Vencevičienė ◽  
Leonas Valius ◽  
Ieva Krivickienė ◽  
Linas Petrauskas ◽  
...  
Keyword(s):  
Risk Factors ◽  
Cardiovascular Risk ◽  
Primary Prevention ◽  
High Risk ◽  
Lipid Lowering ◽  
Blood Pressure Target ◽  
Cvd Risk ◽  
Cross Sectional ◽  
Risk Patients ◽  
Very High

Background and Objectives: Cardiovascular disease (CVD) prevention guidelines define targets for lifestyle and risk factors for patients at high risk of developing CVD. We assessed the control of these factors, as well as CVD risk perception in patients enrolled into the primary care arm of the European Action on Secondary and Primary Prevention by Intervention to Reduce Events (EUROASPIRE V) survey in Lithuania. Materials and Methods: Data were collected as the part of the EUROASPIRE V survey, a multicenter, prospective, cross-sectional observational study. Adults without a documented CVD who had been prescribed antihypertensive medicines and/or lipid-lowering medicines and/or treatment for diabetes (diet and/oral antidiabetic medicines and/or insulin) were eligible for the survey. Data were collected through the review of medical records, patients’ interview, physical examination and laboratory tests. Results: A total of 201 patients were enrolled. Very few patients reached targets for low-density lipoprotein cholesterol (LDL-C) (4.5%), waist circumference (17.4%) and body mass index (15.4%). Only 31% of very high CVD risk patients and 52% of high-risk patients used statins. Blood pressure target was achieved by 115 (57.2%) patients. Only 21.7% of patients at very high actual CVD risk and 27% patients at high risk correctly estimated their risk. Of patients at moderate actual CVD risk, 37.5% patients accurately self-assessed the risk. About 60%–80% of patients reported efforts to reduce the intake of sugar, salt or alcohol; more than 70% of patients were current nonsmokers. Only a third of patients reported weight reduction efforts (33.3%) or regular physical activity (27.4%). Conclusions: The control of cardiovascular risk factors in a selected group of primary prevention patients was unsatisfactory, especially in terms of LDL-C level and body weight parameters. Many patients did not accurately perceive their own risk of developing CVD.

scholarly journals Development and validation of a cardiovascular risk prediction model in type 1 diabetes

Diabetologia ◽  
2021 ◽  
Author(s):  
Stuart J. McGurnaghan ◽  
Paul M. McKeigue ◽  
Stephanie H. Read ◽  
Stefan Franzen ◽  
Ann-Marie Svensson ◽  
...  
Keyword(s):  
Type 1 Diabetes ◽  
Risk Prediction ◽  
Hospital Admissions ◽  
Prediction Tool ◽  
Cvd Risk ◽  
Men And Women ◽  
C Statistic ◽  
Lemeshow Test ◽  
Current Guidelines

Abstract Aims/hypothesis We aimed to report current rates of CVD in type 1 diabetes and to develop a CVD risk prediction tool for type 1 diabetes. Methods A cohort of 27,527 people with type 1 diabetes without prior CVD was derived from the national register in Scotland. Incident CVD events during 199,552 person-years of follow-up were ascertained using hospital admissions and death registers. A Poisson regression model of CVD was developed and then validated in the Swedish National Diabetes Register (n = 33,183). We compared the percentage with a high 10 year CVD risk (i.e., ≥10%) using the model with the percentage eligible for statins using current guidelines by age. Results The age-standardised rate of CVD per 100,000 person-years was 4070 and 3429 in men and women, respectively, with type 1 diabetes in Scotland, and 4014 and 3956 in men and women in Sweden. The final model was well calibrated (Hosmer–Lemeshow test p > 0.05) and included a further 22 terms over a base model of age, sex and diabetes duration (C statistic 0.82; 95% CI 0.81, 0.83). The model increased the base model C statistic from 0.66 to 0.80, from 0.60 to 0.75 and from 0.62 to 0.68 in those aged <40, 40–59 and ≥ 60 years, respectively (all p values <0.005). The model required minimal calibration in Sweden and had a C statistic of 0.85. Under current guidelines, >90% of those aged 20–39 years and 100% of those ≥40 years with type 1 diabetes were eligible for statins, but it was not until age 65 upwards that 100% had a modelled risk of CVD ≥10% in 10 years. Conclusions/interpretation A prediction tool such as that developed here can provide individualised risk predictions. This 10 year CVD risk prediction tool could facilitate patient discussions regarding appropriate statin prescribing. Apart from 10 year risk, such discussions may also consider longer-term CVD risk, the potential for greater benefits from early vs later statin intervention, the potential impact on quality of life of an early CVD event and evidence on safety, all of which could influence treatment decisions, particularly in younger people with type 1 diabetes. Graphical abstract

scholarly journals Deficiencies of Cardiovascular Risk Prediction Models for Type 1 Diabetes

Diabetes Care ◽  
2006 ◽  
Vol 29 (8) ◽  
pp. 1860-1865 ◽  
Author(s):  
J. C. Zgibor ◽  
G. A. Piatt ◽  
K. Ruppert ◽  
T. J. Orchard ◽  
M. S. Roberts
Keyword(s):  
Type 1 Diabetes ◽  
Cardiovascular Risk ◽  
Risk Prediction ◽  
Prediction Models ◽  
Risk Prediction Models ◽  
Cardiovascular Risk Prediction

Performance of cardiovascular risk prediction equations in Indigenous Australians

Heart ◽  
2020 ◽  
Vol 106 (16) ◽  
pp. 1252-1260
Author(s):  
Elizabeth Laurel Mary Barr ◽  
Federica Barzi ◽  
Athira Rohit ◽  
Joan Cunningham ◽  
Shaun Tatipata ◽  
...  
Keyword(s):  
Cardiovascular Risk ◽  
High Risk ◽  
Risk Prediction ◽  
Meta Analysis ◽  
Age Groups ◽  
Future Research ◽  
Indigenous Australians ◽  
Cvd Risk ◽  
Clinical Criteria ◽  
Percentage Difference

ObjectiveTo assess the performance of cardiovascular disease (CVD) risk equations in Indigenous Australians.MethodsWe conducted an individual participant meta-analysis using longitudinal data of 3618 Indigenous Australians (55% women) aged 30–74 years without CVD from population-based cohorts of the Cardiovascular Risk in IndigenouS People(CRISP) consortium. Predicted risk was calculated using: 1991 and 2008 Framingham Heart Study (FHS), the Pooled Cohorts (PC), GloboRisk and the Central Australian Rural Practitioners Association (CARPA) modification of the FHS equation. Calibration, discrimination and diagnostic accuracy were evaluated. Risks were calculated with and without the use of clinical criteria to identify high-risk individuals.ResultsWhen applied without clinical criteria, all equations, except the CARPA-adjusted FHS, underestimated CVD risk (range of percentage difference between observed and predicted CVD risks: −55% to −14%), with underestimation greater in women (−63% to −13%) than men (−47% to −18%) and in younger age groups. Discrimination ranged from 0.66 to 0.72. The CARPA-adjusted FHS equation showed good calibration but overestimated risk in younger people, those without diabetes and those not at high clinical risk. When clinical criteria were used with risk equations, the CARPA-adjusted FHS algorithm scored 64% of those who had CVD events as high risk; corresponding figures for the 1991-FHS were 58% and were 87% for the PC equation for non-Hispanic whites. However, specificity fell.ConclusionThe CARPA-adjusted FHS CVD risk equation and clinical criteria performed the best, achieving higher combined sensitivity and specificity than other equations. However, future research should investigate whether modifications to this algorithm combination might lead to improved risk prediction.

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